CHAPTER 1: THE RELATIONSHIP OF NUTRITION AND HEALTH

MULTIPLE CHOICE 1. Which of the following nutrients helps build and repair body tissues? a protein c fat . . b carbohydrates d all of the above . .

ANS: A PTS: 1 !": A T#P: Nutrients and Their "unctions $. %alnutrition can be caused by &&&&. a eating too 'uch . b eating too little . c . d . both a and b none of the above

ANS: (

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!": A

T#P: %alnutrition

). Which food is considered to have a low nutrient density? a potato chips c apples . . b carrots d stea* . .

ANS: A PTS: 1 !": A T#P: !ndividuals at +is* fro' Poor Nutritional !nta*e ,. There are 'any cu'ulative effects of a poor- unbalanced diet. Which of these disease states 'ay be attributable to a low nutrient density diet? a atherosclerosis c obesity . . b hypertension d all of the above . .

ANS: PTS: 1 !": . T#P: (u'ulative /ffects of Nutrition 0. Which 'ineral is needed to prevent osteoporosis fro' occurring? a iron c 1inc . . b 'agnesiu' d calciu' . .

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iseases

2. A part of a nutrition assess'ent involves anthropo'etric 'easure'ents. What is 'easured during this type of assess'ent? a percentage of 'uscle 'ass c percentage of fat and 'uscle . . tissue b percentage of fat tissue only d percentage of body fluid . .

ANS: .

PTS: 1

!": A

T#P: Nutrition Assess'ent

3. What bioche'ical analysis of blood sa'ples 'ay indicate *idney failure? a seru' albu'in level c creatinine e4cretion . . b seru' transferrin level d blood urea nitrogen . .

ANS:

PTS: 1

!": A

T#P: Nutrition Assess'ent

5. What is the 'ost co''on 'ethod of assessing a client6s dietary history? a three7day food record c three7day food diary . . b $,7hour recall d three7day recall . .

ANS: A

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T#P: Nutrition Assess'ent

8. Which nutrient deficiency displays lesions at the corners of the 'outh? a vita'in . c folic acid . . b riboflavin d iron . .

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19. #besity can increase your ris* of developing a iron deficiency ane'ia c *idney failure . . b diabetes d osteoporosis . .

ANS: . PTS: 1 !": . T#P: (u'ulative /ffects of Nutrition 11. /ducation in good nutritional health practices would eli'inate 'any health proble's that 'ay be caused by 'alnutrition. Which of the following is the best 'ethod for teaching the young child good health habits?

a . b . c . d .

a good health progra' in *indergarten have the physician discuss nutrition with the child i'itation of adult behavior i'itation of eating habits of other children

ANS: ( PTS: 1 !": ( T#P: (onsiderations for the :ealth (are Professional 1$. What is the 'ost co''on for' of nutrient deficiency in the ;nited States? a niacin c protein . . b iron d vita'in ( . .

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iseases

1). Which bioche'ical test 'easures protein status? a seru' transferrin level c seru' albu'in level . . b creatinine e4cretion d seru' creatinine level . .

ANS: (

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1,. Which bioche'ical test indicates a depleted 'uscle 'ass? a seru' transferrin level c seru' albu'in level . . b creatinine e4cretion d seru' creatinine level . .

ANS: .

PTS: 1

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T#P: Nutrition Assess'ent

10. Which blood test can indicate pernicious ane'ia? a he'oglobin test c blood urea nitrogen . . b red blood cell test d lipid profile . .

ANS: A

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T#P: Nutrition Assess'ent

12. Which bioche'ical test indicates iron7carrying protein in the blood? a seru' transferrin level c seru' albu'in level . .

b creatinine e4cretion .

d .

seru' creatinine level

ANS: A

PTS: 1

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T#P: Nutrition Assess'ent

13. Which of the following is characteristics of poor nutritional status? a apathy c both a and b . . b inso'nia d none of the above . .

ANS: ( PTS: 1 !": ( T#P: (haracteristics of <ood Nutrition 15. Which of the following diseases is related to vita'in ( deficiency? a ane'ia c scurvy . . b goiter d 4eropthal'ia . .

ANS: (

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18. Which of the following 'easures is not included in the lipid profile? a glucose c total seru' cholesterol . . b seru' triglycerides d high7density lipoproteins . .

ANS: A

PTS: 1

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T#P: Nutrition Assess'ent

$9. <oiter is a deficiency disease related to deficiency of what nutrient? a iron c calciu' . . b iodine d folic acid . .

ANS: .

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eficiency

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$1. Which of the following are inorganic nutrients? a vita'ins c both a and b . . b 'inerals d none of the above . .

ANS: . PTS: 1 !": . T#P: Nutrients and Their "unctions

SHORT ANSWER 1. Poorly shaped bones or teeth are a sy'pto' of calciu' and vita'in iscuss the relationship between these substances. ANS: =ita'in PTS: 1 is necessary for the utili1ation of calciu' in the body. !": . T#P: eficiency iseases deficiency.

$. Why is a social history i'portant when doing a nutritional assess'ent? ANS: To deter'ine whether the client has the financial resources to obtain the needed food and the ability to store and prepare the food. PTS: 1 !": . T#P: Nutrition Assess'ent

). >ist the 'ethods- or 'eans of data collection- used to co'plete an accurate nutritional assess'ent that is the fra'ewor* for a dietary treat'ent plan. ANS: Social history- $,7hour diet recall- food diary for three to four days- co'puter analysis of the diet- review for any food7drug interactions- review of 'edical records- clinical e4a'inations- and review of results of any bioche'ical tests and anthropo'etrical 'easure'ents. PTS: 1 !": ( T#P: Nutrition Assess'ent

,. The adolescent and the elderly are age groups that are very prone to 'alnutrition. iscuss the reasons for this. ANS: The adolescent responds to peer pressure to deter'ine the types of foods consu'ed ?chips- colas- candy- etcetera.@- and the lifestyle of a teen ?always on the go@ 'ay result in 'any s*ipped 'eals. The elderly are often alone and 'ealti'es can be unpleasant and lonely- resulting in s*ipped 'eals and in eating poorly7balanced 'eals. >iving conditions often do not encourage a healthy appetite. "inancially- so'e elderly 'ay not be able to afford fresh fruits and vegetables or the protein sources of foods. PTS: 1 !nta*e 0. !": ( T#P: !ndividuals at +is* fro' Poor Nutritional

escribe the appearance of an 157year7old fe'ale who is at the opti'al level of nutritional balance. ANS: Shiny hair- clear s*in- clear eyes- erect posture- alert e4pressions- fir' flesh on well7developed bone structure- healthy appetite- regular sleep and eli'ination habits- and positive e'otional adAust'ents.

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T#P: (haracteristics of <ood Nutrition

escribe the pri'ary function?s@ of each of the organic nutrients. ANS: The pri'ary function of carbohydrates and fats is to provide energy. Proteins build and repair body tissues- and vita'ins regulate body processes. PTS: 1 !": . T#P: Nutrients and Their "unctions

3. Wellness is a way of life that integrates 'ind- body- and spirit. What lifestyle habits will help one achieve wellness? ANS: Wellness can be acco'plished through lifestyle habits such as focusing on healthy food choices- not s'o*ing- participating in regular physical activity- and 'aintaining a healthy weight. PTS: 1 !": A T#P: !ntroduction

MODIFIED TRUE/FALSE 1. Appetite is the physiological need for food. :unger is a psychological desire for food. &&&&&&&&&&&&&&&&&&&&&&&&& ANS: "- :ungerB Appetite PTS: 1 !": . T#P: (haracteristics of <ood Nutrition

$. The essential nutrient water provides energy. &&&&&&&&&&&&&&&&&&&&&&&&& ANS: "- regulates body processes PTS: 1 !": . T#P: Nutrients and Their "unctions

). #steoporosis is a dietary deficiency of calciu' and vita'in that causes bones to soften and 'ay cause the spine to bend. &&&&&&&&&&&&&&&&&&&&&&&&& ANS: T T#P: eficiency PTS: 1 iseases !": .

,. The body 'ust be provided with nutrients that are necessary for life. These nutrients are only available in food- 'ust be obtained by the body6s nutritional inta*e- and are *nown as essential nutrients. &&&&&&&&&&&&&&&&&&&&&&&&& ANS: T PTS: 1 T#P: Nutrients and Their "unctions !": A

0. Pri'ary deficiencies are those an individual is born with- while secondary deficiencies are those caused by a disease condition associated with 'alabsorption- accelerated e4cretion- or by destruction of the nutrients. &&&&&&&&&&&&&&&&&&&&&&&&& ANS: "- caused by inadeCuate dietary inta*e PTS: 1 !": . T#P: eficiency iseases

2. !ngestion of 'egadoses of various vita'ins and 'inerals is one of the 'aAor causes of overnutrition in the ;nited States. &&&&&&&&&&&&&&&&&&&&&& ANS: T T#P: %alnutrition PTS: 1 !": .

3. .ioche'ical tests include various blood- urine- and stool tests. A deficiency or to4icity can be deter'ined by a visual analysis of the sa'ples.&&&&&&&&&&&&&&&&&&&&&& ANS: "- laboratory PTS: 1 !": . T#P: Nutrition Assess'ent

5. The deficiency disease beriberi is caused by inadeCuate niacin inta*e.&&&&&&&&&&&&&&&&&&&& ANS: "- thia'in PTS: 1 CASE %s. Wooly brought her daughter- %ary- age 1,- to the health care center to be seen by the nurse for a referral to the physician. Together- they tell the nurse that %ary has had nausea- vo'iting- and headaches for the past two wee*s. She has vo'ited Dal'ost every day.E %s. Wooly began to cry as she tells the nurse that %ary does not re'e'ber the date of her last 'enstrual period and that she is afraid that %ary is pregnant. uring this interchange- %ary appears stoic and does not cry or have any verbali1ations. After a blood test confir'ed the pregnancy- %s. Wooly beca'e cal'er. A prenatal assess'ent was begun. %s. Wooly answered 'ost of the Cuestions even though they were directed at %ary. >ast 'enstrual period was esti'ated to be two 'onths ago. %enses onset began two years ago. :t: 065E Wt: 19) %ediu' fra'e si1e She described her usual dietary inta*e as including ha'burgers- hot dogs- chipscandy- and colas. %ary denies alcohol- drug- or cigarette use. %ary would not discuss the father of the child- nor did she volunteer any additional infor'ation. !t is evident that %ary has so'e urgent needs that 'ust be addressed during this visit. %ary 'ust accept the pregnancy- but she 'ust also begin to eat properly to 'eet her nutritional needs and those of the infant. !": A T#P: eficiency iseases

1. Proble' nutrients for teen pregnancies include calciu'- 1inc- iron- vita'in Avita'in (- and protein. What are the nutritional needs for each of these nutrients for a pregnant teenager? ANS: (alciu': ?under 15@ 1)99 'g =ita'in A: 309 'g Finc: 1) 'g =ita'in (: 59 'g !ron: $3 'g Protein: 1.03G1.3 gH*g body weight PTS: 1 !nta*e !": . T#P: !ndividuals at +is* fro' Poor Nutritional

$. State three nursing diagnosis state'ents fro' the assess'ent data. ANS: Altered nutrition: less than body reCuire'ents related to adolescent pregnancywhen her own needs for growth and 'aturation are still high and eating habits are poor. Inowledge deficit related to nutritional reCuire'ents during pregnancy. An4iety related to changes- disco'forts- or e'otional feelings resulting fro' pregnancy. PTS: 1 !nta*e !": ( T#P: !ndividuals at +is* fro' Poor Nutritional

). >ist nursing interventions to help %ary achieve an adeCuate nutritional status. ANS: ;sing the %yPyra'id- teach %ary nutritional needs during pregnancy and the characteristics of an adeCuate diet. :elp %ary individuali1e her diet so that she achieves an adeCuate inta*e. Teach %ary strategies for coping with nutrition7 related disco'forts of pregnancy. Advise %ary to use nutritional supple'ents- vita'ins- and iron appropriately. (onsult with and 'a*e referrals to other professionals- dietician- social servicesand other progra's developed to aid pregnant wo'en- such as the Special Supple'ental Progra' for Wo'en- !nfants- and (hildren ?W!(@. PTS: 1 !": ( T#P: (are Planning

,. %ary6s age- physical sy'pto's- and diagnosis will factor into her care. Teen pregnancy is i'pacted by several life cycle needs- and also covers a broad range of develop'ental needs based on the pregnancy and the wo'an6s age. iscuss the factors associated with nutrition and identify goals to help %ary obtain a successful outco'e. ANS:

%ary is a pregnant teenager. She still has the pressures of being a teenager and the de'ands of eating nutritionally. !n addition to eating properly for the fetus%ary is still growing and developing with her own nutritional needs. She will also have cravings related to fast foods or e'pty calories and aversions to 'eat and eggs. :er list of Dusual foodsE shows how difficult it will be for her to change her dietary habits and eat healthily. <oal 1: %ary will verbali1e understanding of the rationale for eating a nutritious diet. <oal $: %ary will select foods and 'a*e a 'eal plan that adheres to dietary guidelines for a pregnant teen. PTS: 1 !nta*e 0. !": ( T#P: !ndividuals at +is* fro' Poor Nutritional

escribe the usual weight gain reco''ended for a pregnant adolescent who is at the reco''ended weight for her height- for an overweight teen- and for an underweight teen. !dentify reco''ended a'ounts of each vita'in or 'ineral that is i'portant during pregnancy. ;se your te4t- other te4tboo*s- or an !nternet source to deter'ine the reco''ended dietary allowances ?+ As@. ANS: The reco''ended weight gain for a teenager should be at the higher end of the range. A gain of 1 pound ?lb@ per wee* in the second and third tri'esters of pregnancy is advised. !f the adolescent is underweight- a ,97lb gain is reco''endedB for nor'al weight- )0 lbsB and $0 lbs for an overweight teen. <enerally- pregnant adolescents should consu'e not fewer than $-999 calories per day. !n 'any cases- higher caloric inta*es are needed. !ron )9 'g is reco''ended for all pregnant wo'en. !f the adolescent consu'es fewer than 299 'g per day of calciu'- supple'entation of 299 'g is reco''ended- in addition to the usual inta*e for nonpregnant teens. %ultivita'ins and folate are reco''ended for all adolescents. PTS: 1 !": ( T#P: (are Planning iscuss the benefits and goals and

2. (ontact the W!( progra' in your co''unity. describe the positive outco'es.

ANS: An individuali1ed nutritional ris* profile is developed for each person and a specific nutritional rehabilitation progra' is deter'ined. <oals are increased birth weight- decreased preter' delivery- and decreased 'aternal 'orbidity and perinatal 'orbidity and 'ortality. PTS: 1 !nta*e !": ( T#P: !ndividuals at +is* fro' Poor Nutritional

3. When %ary hears the nurse tell her she will need to increase her caloric inta*eher first response to the nurse was- D%ore chips- candy- colas.E What is the nurse6s response? ANS:

The %yPyra'id 'ust be used as a basis for daily food choices. The nurse 'ust 'a*e %ary understand that the weight gain 'ust be fro' desirable foods- and e'phasi1e the i'portance of choosing a varied diet. The e'pty calories that %ary prefers provide no nutritional value. PTS: 1 !": . T#P: (are Planning

5. .efore a 'eaningful e4change of infor'ation will occur with %ary- the nurse 'ust first build a trusting relationship and establish good co''unication lines. escribe the setting that will be 'ost conducive to beginning this dialogue. Who will be present? What will help %ary be rela4ed and feel nonthreatened? escribe positive co''unication techniCues that will be useful. :ow should the session begin? ANS: evelop'ent of a trusting relationship should begin with the nurse 'eeting with %ary alone. Allow her to be in a co'fortable position. Sit on a couch ne4t to hernot behind a des* with her facing you. ;se open7ended Cuestions- e4ploratory state'entsB and body language that is nonthreatening so %ary will feel co'fortable. on6t as* leading Cuestions such as- DJou don6t drin* or s'o*e potdo you?E .egin by tal*ing about daily events to put %ary at ease. As the conversation progresses- use silence to allow %ary to gather her thoughts. Spea* with %ary as an adult. /ncourage Cuestions fro' her. PTS: 1 !": ( T#P: (are Planning

%r. >ew was transported to the e'ergency roo' ?/+@ by e'ergency transport. (ity police officers called an a'bulance after finding %r. >ew lying in an alley with apparent unconsciousness. The e'ergency 'edical tea' started an intravenous ?!=@- and upon arriving at the /+ %r. >ew had regained consciousness but is now unconscious again. Physical data collected included: Physical appearance is un*e'pt and dirty. #dor suggests consu'ption of alcohol is li*ely. T 82- P 1$,- + )2- .HP 89H,9 =ery e'aciated appearance >egs and ar's very dry and fla*y %ottled purplish areas to lower e4tre'ities /de'a )K in an*les and lower legs Abdo'en tight and distended "acial color and nail beds pale No response to painful or verbal sti'uli After physician e4a'ination- %r. >ew was ad'itted to the hospital with 'alnutrition- +H# pancreatitis- and cirrhosis of the liver due to /T#: abuse. 8. %r. >ew has no fa'ily or friends present and his level of awareness will greatly restrict data collection. >ist the data collection 'ethods that are available considering %r. >ew6s condition. !dentify any tools you will need to collect assess'ent data to begin the planning phase. ANS:

ata collection 'ethods include a physical e4a'ination- including anthropo'etric 'easure'ents- a nursing history- and bioche'ical analyses. When %r. >ew regains co'plete orientation- a dietary history and dietary recall can be done. Scales- tape 'easure- and a stethoscope are needed. A dietary history will be difficult to co'pleteB however- as the location of his body ?in an alley@ 'ay indicate the type of lifestyle he has been leading. Tools needed will vary but 'ay include paper- pencil- ther'o'eter- stethoscope- sphyg'o'ano'eter- and watch. PTS: 1 !": ( T#P: Nutrition Assess'ent

19. >ist data that will be assessed. ANS: /yes should be bright and shinyB assess gu's for caries- lesions- 'issing teethgu's ede'atous- and presence of bleedingB face and s*in dry- scaly- or s'ooth and fir'B tongue for redness- bu'piness- and roughnessB nails fir' and pin*B postureB wasted appearanceB refle4esB vital signsB fat7fold 'easuresB height and weight. PTS: 1 !": ( T#P: Nutrition Assess'ent

11. !dentify the bioche'ical analyses that should be 'onitored. ANS: Seru' albu'in- he'atocrit- he'oglobin- electrolytes- glucose- .;N- cholesteroluric acid- calciu'- 'agnesiu'- en1y'es- creatinine- iron PTS: 1 !": ( T#P: Nutrition Assess'ent

1$. !dentify goals for %r. >ew- relating to nutrition. .e specific as to protein needs. ANS: %r. >ew will: stabili1e fluid and electrolyte balance within $,G,5 hoursB receive adeCuate nutrients to 'eet nutritional needsB gain 9.$0G9.0 lbH*g a wee*. PTS: 1 !": ( T#P: (are Planning

1). "or each goal- what outco'e data will verify that the goals have been 'et? ANS: "luid inta*e and output will be balanced and vital signs nor'al. Nutritional therapy will be ongoing. #verall physical indicators 'ay not be notable for several wee*s- considering the ti'e period it 'ay have ta*en to reach the level of e'aciation. Weight will be fluctuating at firstB a stable weight with gain will validate the goal. An adeCuate diet for %r. >ew will be necessary for the rest of his life. >aboratory values will be stable- within nor'al li'its- within ,5 hours. PTS: 1 !": ( T#P: (are Planning

1,. #f the goals identified- which is the highest in priority?

ANS: Nor'al laboratory values are the highest priority. !n his present condition it is of ut'ost need to stabili1e his body6s fluid and electrolyte balance. PTS: 1 !": . T#P: (are Planning

10. !dentify nursing interventions to 'eet the identified goals. ANS: Weigh daily- 'onitor ! L # hourly- 'onitor .HP- T- P- + rate- breath sounds- and ede'a. %onitor lab values: glucose- vita'ins- 'inerals- trace ele'entselectrolytes- albu'in- and .;N. %outh care every two hours. #ffer s'all- freCuent feedings. (ollaborate with dietician for a progressive diet- high in nutrients. %onitor calorie count for three days. Assess client6s *nowledge of a balanced diet. Provide positive reinforce'ent for food inta*e. PTS: 1 12. !": ( T#P: (are Planning

escribe the role alcohol has played in %r. >ew6s nutritional status. ANS: Alcohol produces euphoria that results in depressed appetite and i'pacts the diet of a drin*er. People afflicted in this 'anner tend to eat very little. The alcohol is rich in calories and energyB however alcohol provides e'pty calories. The 'ore one drin*s- the less food is eaten. /ven when food is eaten- the alcohol interferes with the body6s ingestion- digestion- absorption- 'etabolis'- and e4cretion of nutrients. Nutrient deficiencies are an inevitable result of alcoholis'. PTS: 1 !": ( T#P: (are Planning